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Majority of Patients With RA Unaware of Risk for Cardiovascular Disease
Patients with rheumatoid arthritis who are at greatest risk for developing cardiovascular disease are largely unaware of the comorbidity, according to recent data in Arthritis Research & Therapy.
“In order to empower patients to become active participants in CVD prevention strategies, an understanding of their awareness regarding CVD is required first,” Olivia R. Ghosh-Swaby, MS, of the Western University Schulich School of Medicine and Dentistry in London, Ontario, Canada, and colleagues wrote. “Little is known about RA patients’ knowledge about the association between RA and CVD, or how their perceived and actual CVD risk may differ.”
To analyze the overall awareness and perceived risk among patients with RA regarding the connection between RA and CVD, Ghosh-Swaby and colleagues conducted a systematic literature search of three electronic databases — Medline, Embase and PubMed. The researchers limited their search to English-language articles published from 1990 to June 20, 2018, featuring observational studies surveying adult populations with RA, with search terms related to RA, CVD, awareness and perceptions of CVD risk.
Two independent reviewers screened a total of 33 abstracts for inclusion or exclusion, of which six were included in the final analysis. These six abstracts provided a sample size of 478 participants, including those with established RA, with a mean age range of 53 to 64 years.
According to Ghosh-Swaby and colleagues, the vast majority of participants, ranging from 73% to 97%, were unaware of the increased risk for CVD associated with RA. In addition, this lack of awareness frequently occurred in patients with RA who demonstrated a greater number of traditional risk factors for CVD.
The researchers also noted that RA disease characteristics linked to CVD, such as the use of disease modifying antirheumatic drugs, corticosteroids or NSAIDs, were not uniformly reported. Misperceptions about CVD were also common, with the majority of participants misestimating their actual individual risk.
“We encourage additional studies and pragmatic trials of RA-specific educational interventions to be conducted,” Ghosh-Swaby and colleagues wrote. “These will help determine if knowledge gains are sustainable and have substantive impact on long-term CVD outcomes in RA. However, based on our findings, these interventions must be flexible in format, be designed with the input of content experts, including patients themselves and, above all, be tailored to meet the needs of patients.”
“A deeper understanding of the system-, physician-, and patient-level barriers preventing optimal awareness of this comorbidity is also needed,” the researchers added. “Only then will interventions to improve CVD screening and management in RA be truly successful.” – by Jason Laday
Disclosure: Ghosh-Swaby reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
Perspective
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Increased risk of CVD in RA is well recognized in the scientific rheumatologic community. However, translating this knowledge into clinical practice with the goal of improved CVD outcomes in RA is challenging on several levels, including system, provider and, of course, the patient who are major stakeholders in this problem.
The systematic review by Ghosh-Swaby and Kuriya addresses a fundamental problem of tackling the CVD risk improvement in RA on the patient level: Low awareness among patients about their CVD risk as well as the role of RA in their CVD risk.
This review unravels the disconnect between well-informed rheumatology providers — and perhaps providers in other specialties — and poorly-informed patients with regards to CVD disease in RA. Great effort has been made to spread the knowledge about heightened CVD risk in rheumatic disease in medical community, but these efforts did not progress to involve patients. Unless patients are informed and educated about increased CVD risk associated with their RA and the role of modifiable and non-modifiable CVD risk factors, they are not likely to be engaged in interventions aimed at CVD risk reduction in RA.
The article points out that patients with RA may be preoccupied primarily with control of their disease, which is completely understandable. The majority of RA patients have several chronic conditions, in addition to RA and it takes multidisciplinary team and coordinated approach to care to help patients in navigating through their disease. Individual patient preferences and needs for delivering educational and counseling/coaching interventions on CVD risk in RA need to be studied to effectively address patients’ needs and their best interests.
Perspective
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CVD prevention has gained traction in the rheumatology world in the last few years, as more and more providers are aware of the risk of CVD in most of our diseases. The article by Ghosh-Swaby and Kuriya explores if patients with RA are aware of their own risk. According to the researchers, the risk of coronary artery disease, myocardial infarction and stroke increases by as much as 82%, 68%, and 41%, respectively, yet adherence to CVD quality indicators in the clinical practice appears to be low.
Through a systematic literature review, six studies assessed patient awareness of their risk of CVD. According to the researchers, 73% to 97% of patients were unaware of their risk. One study done by Barber and colleagues revealed that nearly half of all patients and primary care providers were unaware of the link between RA and CVD.
The article also explored how education can help patients engage in positive behavioral change, including medication compliance and lifestyle changes. One interesting study by Jolly and colleagues tested a web-based educational intervention to improve CVD awareness among RA patients. Other possibilities can include the use of apps and or links to educational materials through the patient-accessed electronic medical records, or through computers or tablets in waiting rooms.
There is yet no data to suggest that knowledge of CVD risk will translate into positive CVD outcomes in RA. More studies are necessary to explore what educational interventions would work best, and these must be designed to meet the needs of patients.